Paulson Menstral disorders

Question 1

In the US average age of puberty is between _________

Answer 1

8-13

Question 2

_________ increase in androgens befoe the onset of puberty

Answer 2

adrenarch

Question 3

____________ is breast development and requires (2 hormones)

Answer 3

thelarche, estrogen and progesterone

Question 4

Menarche requires 5 hormones and ______ (anatomy)

Answer 4

GnRh, FSH, LH, progesterone, estrogen, normal outflow tract

Question 5

pubertal development before 8 age in girls and 9 in boys is called

Answer 5

precocious puberty

Question 6

average age to start menstrating is 12-13, _____ years after breast bud development

Answer 6

2.5

Question 7

Normal cycle is ___________

Answer 7

28 days +/- 7 days

Question 8

primary amenorrheas the abscens of spontaneous mentrastion by age________ with no secondary sex characteristic or ________ with prescesn of secondary sex characteristics

Answer 8

13, 15

Question 9

4 main categories of primary amennorhea

Answer 9

ovarian dysfunction, pituitary dysfunction, hypothalamic dysfunction, outflow obstruction

Question 10

example of ovarian dysfunction

Answer 10

turners syndrome. congenital development disorder of the repro system (sex chromosome abnormality)

Question 11

example of hypothalamic dysfunction

Answer 11

GnRH pulse is messed up: Kallmanns (idopathic hypogonadotropic hypogonadism) + anosmia
Anoexia, excercise

Question 12

Pituitary dysfunction examples

Answer 12

Sheehans syndrom (infartion of pitutatry d/t hemmorhage)

Question 13

Outflow tract obstruction due to _________

Answer 13

imperforate hymen

Question 14

How to work up primary amennohea. 1) sex characteristics Y/N

Answer 14

yes-outflow problem
No- check fhs/lh karyotype

Question 15

Secondary amenorrhea defined:

Answer 15

cessation of previsouly present and regular menses for 3 months or irrecular menses for 6 months

Question 16

M/C reasons for secondary amennhorehea (6)

Answer 16

pregnancy, PCOS, OCPS/meds, dibetes, hyper/hypothyroidsm, surgery

Question 17

workup for secondary amenorrhea

Answer 17

1)preg test
2)check tsh/prolactin
3) progesterone challenge test
4) check FSH/LH

Imaging: CT or MR of hypothalamus, pit or pelvis

Question 18

Progesterone challenge test is done by giving progesterone medication to a woman who doesn’t get periods to try to induce a period .
Med/dose and expected result

Answer 18

Provera 5mg BID x 5-7 days
+ withdraw bleed within 2-7 days

Question 19

A + progesterone challenge test means that there is ________ present but is not __________. If no withdrawal bleeding occurs the patient either has very low ____________ or there is a problem with ___________

Answer 19

estrogen, ovulating
estrogen, outflow tract (adhesions)

Question 20

Mullerian agensis is when the _________- doesnt develop properly

Answer 20

uterus

Question 21

PCOS…consider screenign for ________-

Answer 21

metabolic syndrome, losely related to insulin resistance

Question 22

Rotterdam criteria is used to dx ___________. Include criteria

Answer 22

PCOS. 2/3 hyperandrogenism, ovulatory dysfunction, polycycstic ovaries

Question 23

Rotterdam criteria:

Answer 23

2/3: hyperandrogensim, polycycstic ovaries, issues ovulating

Question 24

Polycycsti ovary is defines as and ovary with _______ or more follicles measuring _____-______ mm , or ______+ml

Answer 24

12, 2-9mm
10

Question 25

s/sx of PCOS

Answer 25

acne, male hair loss patterns, thick/heavy facial and body hair growth, obestiy, irregular menses, skin tags, acanthosis nigracans

Question 26

Tx for PCOS

Answer 26

OCA, metformin (used in cases of hyperglycemia), weight loss,

Question 27

screen for _____ (4)in PCOS

Answer 27

lipids, BP, sleep apnea, dpression, DM

Question 28

MEds that cause amenohrrea (4anties on oncol)

Answer 28

anti: phycs, depressants, histamines, hypertensives, opiates

Question 29

female athlete triad

Answer 29

amenorrhea, low bone density, eating disorder

Question 30

female athlete triad

Answer 30

amenorhhea, osteopenia, eating disorder

Question 31

_______________ are the most frequent pituitary tumor and inhibit GnRH resulting in low __________ and _______ levels

Answer 31

prolactinoma, estrogen and gonadotropin

Question 32

primary dysmennhohera is caused by excessive __________ secretion in menstrual fluid with a usual onset within 3-6 months of menarch. peaks late teens, early 20s'

Answer 32

E2 prostaglandin

Question 33

Secondary dysmen has a _________ cause

Answer 33

pathologic

Question 34

in primary dysmennohreah you may have gneneralized pelvic tenderness, N/V/D, typically _________ (when does it happen)

Answer 34

first day of menses

Question 35

In secondary dsymenorrhea pain lasts _____________

Answer 35

longer than a menstraul period

Question 36

Secondary is usuallly (age)___________ and timeline

Answer 36

older (25+) than primary, starts prior to menses, worsens and persists

Question 37

causes for secondary dysmen

Answer 37

endometriosis, adenomyosis, IUD, cervical stenosis, fibroids, PID

Question 38

__________ is a big risk factor for dysmennorhhea

Answer 38

heavy menses

Question 39

TX for dysmennohhea

Answer 39

NSAIDS (most effective), tyelnol, heat, OCPs, excercise, TENS

Question 40

NSAIDS for dysmenor

Answer 40

IBUPROPHEN (very effective in reducing prostaglandins)

Question 41

Most common cause for AUB

Answer 41

PALM COIEN Polyp Adenomyosis Leiomas Malignancy/hyperplasia Coag issues Ovulatory issues Endometrial Iatrogenic Not otherwise classed

Question 42

PALM COIEN

Answer 42

Polyps Adenomyosis Lieomyoma Malignancy/hyperplasia Coag Ovulation probs Endometrial Iatrogenic Not otherwise speci

Question 43

if a patien is 45+ with AUB, what must you do

Answer 43

endometrial biopsy

Question 44

if thre is a palpable mass on PE with somewith AUB, what imagining would you perform

Answer 44

transvaginal US

Question 45

TX for AUB

Answer 45

IUD (levono-mirena), COC's, continueous POP's, TXA (safe when trying to get preggers), hysterectomy and endometrial ablation when done having kids

Question 46

Heavy mentral bleeding in adolescent may be 1st sign of bleeding disorder. In the acute phase you can treat with __________, maintanenc therapy includes ________

Answer 46

estrogen, injectibale progestin (depo), levo IUDS (mirena)

Question 47

Acute AUB in repro age people Tx

Answer 47

IV estrogen, OCPs (monophasic of ethinl estradiol TIDx 7days) DEPO +COC TXA REFER TO GYN

Question 48

Iv estrogen is contraindicated in

Answer 48

breast cancer hx, DVT, liver dz

Question 49

PMS sx occur in which phase

Answer 49

luteal

Question 50

PMS can be dxed if they repor sx during the ____ days prior to menses and ends within ______ after onset of menses

Answer 50

4, 5

Question 51

PMDD diagnosis

Answer 51

5/11 listed sx

Question 52

how to treat PMDD

Answer 52

SSRIS Prozac Zoloft Lexapro Celexa